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Intracameral Triamcinolone Acetonide Versus Topical Dexamethasone: a Comparison of Anti- Inflammatory Effects After Phacoemulsification

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Intracameral Triamcinolone Acetonide Versus Topical Dexamethasone: a Comparison of Anti- Inflammatory Effects After Phacoemulsification Open Access Original Article DOI: 10.7759/cureus.7592 Intracameral Triamcinolone Acetonide Versus Topical Dexamethasone: A Comparison of Anti- inflammatory Effects After Phacoemulsification Kamran Haider Shaheen 1 , Muhammad Saad Ullah 1 , Syed Ahmer Hussain 1 , Aamir Furqan 2 1. Ophthalmology, District Headquarter Teaching Hospital, Dera Ghazi Khan, PAK 2. Anesthesia and Critical Care, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK Corresponding author: Kamran Haider Shaheen, [email protected] Abstract Study objective and design The objective of this study was to determine the effectiveness of triamcinolone acetonide when used as a single dose as compared to the topical use of dexamethasone to control the inflammation after phacoemulsification. The study was a randomized controlled trial conducted in the Department of Ophthalmology at the District Headquarter (DHQ) Teaching Hospital, Dera Ghazi Khan, from March 1, 2018, to August 31, 2019. Materials and methods Eighty patients were included in the study. All patients were assigned to two groups of 40 patients each using the lottery method. Group A patients were treated with a 1-mg intracameral injection of triamcinolone acetonide postoperatively after phacoemulsification. Group B patients were administered 0.1% dexamethasone eye drops with a dosage of one drop every four hours for four weeks. Postoperative follow- up was planned for day one, day seven, and day 28. Results The postoperative inflammation cell values of Group A on day one, day seven, and day 28 were 1.68 ±0.84, 0.22 ±0.15, and 0.12 ±0.23, respectively, while the postoperative inflammation cell values of Group B on day one, day seven, and day 28 were 1.91 ±0.75, 0.28 ±0.15, and 0.09 ±0.20, respectively. The postoperative inflammation flare values of Group A on day one, day seven, and day 28 were 0.31 ±0.37, 0.03 ±0.44, and 0.00 ±0.22, respectively, while the postoperative inflammation flare values of Group B on day one, day seven, and day 28 were 0.25 ±0.26, 0.22 ±0.46, and 0.02 ±0.18, respectively. Conclusion The efficacy of both modes of treatments is comparable; however, triamcinolone acetonide is preferable to Received 03/19/2020 Review began 03/27/2020 dexamethasone, as its intracameral injection generally results in better compliance than multiple dosages of Review ended 04/01/2020 topical eye drops of dexamethasone. Published 04/08/2020 © Copyright 2020 Haider Shaheen et al. This is an open Categories: Ophthalmology access article distributed under the terms Keywords: cataract, inflammation, phacoemulsification, triamcinolone of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the Introduction original author and source are credited. Cataract is the most common cause of treatable blindness worldwide, with approximately 51.5% of blindness cases attributed to cataract [1,2]. People who are ≥50 years old are most commonly affected by cataracts, resulting in visual impairment (i.e., almost 65% worldwide) [3]. With the recent advancements in medical care and living standards throughout the world, the average age of the population is increasing along with the total population, which ultimately could result in an increased incidence of cataract cases. In both developing and developed countries, cataract is the leading cause of vision loss [4]. Similarly, cataract surgery is the most common procedure performed by ophthalmologists all over the world [5]. According to research, nearly 18 million cataract surgeries are performed by ophthalmologists to treat cataracts every year, and this number is on the rise along with the increasing population and average age of the population in the world [6]. The gold standard of treatment and the most commonly performed surgery for cataracts is small incision surgery with phacoemulsification [7]. However, postoperative inflammation can result in complications such as raised intraocular pressure (IOP), cystoid macular edema, increased recovery time, or formation of synechiae [8,9]. The most common treatment option for postoperative inflammation is topical steroids. Apart from the topical route, other means of administration of steroids include intravitreal, intracameral, How to cite this article Haider Shaheen K, Ullah M, Hussain S, et al. (April 08, 2020) Intracameral Triamcinolone Acetonide Versus Topical Dexamethasone: A Comparison of Anti-inflammatory Effects After Phacoemulsification. Cureus 12(4): e7592. DOI 10.7759/cureus.7592 subtenon, and subconjunctival [10]. Triamcinolone, when used via intracameral route, has a 100% effect after four weeks of phacoemulsification and is completely safe for treating postoperative inflammation after cataract surgery [11]. Waseem et al. conducted a study in Pakistan on the use of topical 0.1% dexamethasone, and the results showed that it was effective in 98% of cases after five weeks of phacoemulsification [12]. We are performing this study to compare the overall efficacy and safety of intracameral triamcinolone used as a single dose with topical use of dexamethasone for the treatment of postoperative inflammation in the local population. We believe this study will enable us to provide recommendations regarding the use of a more efficacious treatment option for the reduction of postoperative inflammation after phacoemulsification. Materials And Methods This randomized controlled trial was conducted in the Department of Ophthalmology at the District Headquarter (DHQ) Teaching Hospital, Dera Ghazi Khan, from March 1, 2018, to August 31, 2019. Approval for the study was obtained from the hospital’s ethics committee. The study conducted by Manzoor et al. was used to calculate the sample size [13]. Eighty patients were included in the study. Inclusion criteria included patients of either gender between the ages of 40 to 70 years who were admitted to the Department of Ophthalmology for phacoemulsification for cataract. Patients with any ocular pathology, anterior uveitis, or any intraoperative complication during surgery such as vitreous loss or posterior capsular rupture, history of prior surgery, and other comorbid conditions were excluded from the study. Phacoemulsification with foldable lens implantation was performed under local anesthesia. All procedures were performed by a consultant surgeon with at least five years of experience. Group A patients were treated with 1-mg intracameral injection of triamcinolone acetonide postoperatively after phacoemulsification. Group B patients were administered 0.1% dexamethasone eye drops with a dosage of one drop every four hours for four weeks. All 80 patients were given 0.5% moxifloxacin eye drops at the rate of one drop every six hours for four weeks. Postoperative follow-up was planned for day one, day seven, and day 28. Inflammation was assessed based on cells in the anterior chamber and aqueous flare. Grading for cells in the anterior chamber was done as follows: grade 0=50. Similarly, aqueous flare grading was done as follows: 0=none, 1=just detectable or mild, 2=iris details clear or moderate, 3=iris details hazy or marked flare, 4=severe flare or heavy clots and fibrin deposits. IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY) was used to perform the statistical analysis. Means and standard deviation were calculated for quantitative variables such as age, while frequency and percentage were calculated for qualitative variables such as gender. A Chi-square test was applied to compare the two groups in terms of efficacy. A p-value of ≤0.05 was considered statistically significant. Results Eighty patients of both genders were included in this study. The mean age of Group A was 50 ±5 years. There were more male patients (n=22; 55%) than female patients (n=18; 45%). The mean age of patients in Group B was 51 ±4 years. In group B also, there were more male patients (n=29; 72.5%) than female patients (n=11; 27.5%). The differences were statistically insignificant (Table 1). Variable Group A (n=40) Group B (n=40) P-value Mean age (years) 50 ±5 51 ±4 0.362 Gender Male 55% (n=22) 72.5% (n=29) 0.068 Female 45% (n=18) 27.5% (n=11) TABLE 1: Demographic characteristics of both groups The postoperative inflammation cell values of Group A at day one, day seven, and day 28 were 1.68 ±0.84, 0.22 ±0.15, and 0.12 ±0.23, respectively, while the postoperative inflammation cell values of Group B at day one, day seven, and day 28 were 1.91 ±0.75, 0.28 ±0.15, and 0.09 ±0.20, respectively. The postoperative inflammation flare values of Group A at day one, day seven, and day 28 were 0.31 ±0.37, 0.03 ±0.44, and 0.00 ±0.22, respectively, while the postoperative inflammation flare values of Group B at day one, day seven, and day 28 were 0.25 ±0.26, 0.22 ±0.46, and 0.02 ±0.18, respectively. The differences were statistically insignificant (Table 2). 2020 Haider Shaheen et al. Cureus 12(4): e7592. DOI 10.7759/cureus.7592 2 of 5 Group A (n=40) Group B (n=40) P-value Day 1 1.68 ±0.84 1.91 ±0.75 0.094 Cells Day 7 0.22 ±0.15 0.28 ±0.15 0.123 Day 28 0.12 ±0.23 0.09 ±0.20 0.662 Day 1 0.31 ±0.37 0.25 ±0.26 0.427 Flare Day 7 0.03 ±0.44 0.22 ±0.46 0.084 Day 28 0.00 ±0.22 0.02 ±0.18 0.685 TABLE 2: Postoperative outcomes in both groups The mean IOP values of Group A at preoperative, day one, day seven, and day 28 were 17.14 ±2.17 mmHg, 17.78 ±2.75 mmHg, 15.54 ±2.46 mmHg, and 13.44 ±1.52 mmHg, respectively, while the mean IOP values of Group B at preoperative, day one, day seven, and day 28 were 16.02 ±2.55 mmHg, 17.43 ±3.36 mmHg, 15.41 ±2.21 mmHg, and 13.21 ±1.65 mmHg, respectively.
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